Provider Demographics
NPI:1013079755
Name:ALEUTIAN PRIBILOF ISLANDS ASSOCIATION, INC
Entity type:Organization
Organization Name:ALEUTIAN PRIBILOF ISLANDS ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILEMONOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-276-2700
Mailing Address - Street 1:1131 E. INTERNATIONAL AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518
Mailing Address - Country:US
Mailing Address - Phone:907-276-2700
Mailing Address - Fax:907-279-4351
Practice Address - Street 1:934 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:AK
Practice Address - Zip Code:99591
Practice Address - Country:US
Practice Address - Phone:907-859-2254
Practice Address - Fax:907-859-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QC1500X
172V00000X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL0005Medicaid
AKCLOOO5Medicaid